Global Practices of Peri-Operative Antibiotic Use in HoLEP Surgery
Overview
This study surveyed urologic surgeons worldwide to assess peri-operative antibiotic prescribing patterns for Holmium Laser Enucleation of the Prostate (HoLEP). Results revealed significant variability, particularly in patients with indwelling or intermittent self-catheterization (C/ISC), with private practice surgeons more likely to prescribe extended antibiotic courses than academic or hospital-employed counterparts.
Background
Holmium Laser Enucleation of the Prostate (HoLEP) is an effective, size-independent surgical treatment for benign prostatic hypertrophy (BPH) recommended by the American Urological Association. Despite its advantages, HoLEP adoption remains limited due to a steep learning curve. Preventing post-operative infections such as urinary tract infections and sepsis is critical, yet consensus on peri-operative antibiotic prophylaxis, especially in patients with indwelling catheters, is lacking. This study aimed to evaluate global surgeon practices regarding antibiotic use around HoLEP procedures.
Data Highlights
Clinical Scenario
Antibiotic Practice
Percentage of Urologists
Negative urine culture, no catheter
Single-dose peri-operative antibiotic only
95.7%
Negative urine culture, catheterized/ISC
Single-dose peri-operative antibiotic only
51.4%
Negative urine culture, catheterized/ISC
Additional pre-operative prophylaxis (3 days)
28.6%
Negative urine culture, catheterized/ISC
Post-operative antibiotics (5 days most common)
24.2%
Positive urine culture
Antibiotic treatment prior to HoLEP (7 days most common)
43.5%
Practice setting effect on post-op antibiotics (negative culture, no catheter)
Private practice vs Academic vs Hospital-employed
75.0% vs 64.6% vs 11.0%
Practice setting effect on post-op antibiotics (negative culture, catheterized)
Private practice vs Academic vs Hospital-employed
92% vs 66% vs 22%
Key Findings
95.7% of surgeons prescribe a single peri-operative antibiotic dose for patients with negative urine cultures and no catheterization.
For catheterized or intermittently self-catheterizing patients with negative cultures, nearly half of surgeons prescribe extended antibiotic prophylaxis pre- or post-operatively.
Private practice surgeons are significantly more likely to prescribe post-operative antibiotics compared to academic or hospital-employed surgeons.
Surgeons tend to use broader-spectrum antibiotics and longer durations in patients with catheterization history.
All surgeons treat positive pre-operative urine cultures with antibiotics prior to HoLEP, most commonly for seven days.
More experienced surgeons tend to prescribe shorter antibiotic courses for positive urine cultures.
Clinical Implications
Clinicians should recognize the variability in peri-operative antibiotic practices for HoLEP, especially in patients with indwelling catheters. Adhering to evidence-based guidelines recommending single-dose prophylaxis in low-risk patients may reduce unnecessary antibiotic exposure. Tailoring antibiotic choice and duration based on catheter status and urine culture results is important to balance infection prevention with antimicrobial stewardship.
Conclusion
This survey highlights diverse global practices in peri-operative antibiotic use for HoLEP, influenced by catheter status and practice setting. Standardized guidelines are needed to optimize antibiotic stewardship while minimizing infectious complications in HoLEP patients.
References
American Urological Association Guidelines 2020 -- Management of BPH
Endourological Society Survey 2023 -- Peri-operative Antibiotic Use in HoLEP
by Seyed Mohammad Mohaghegh Poor, Hafsa Asif, Darion Denis-Diaz, Eric Riedinger, Tasha Posid, Maxwell Newton, Michael Sourial, Mark Assmus, Amy Krambeck, Bodo Knudsen, Matthew Lee
